How governmental spending can impact infant mortality


An investigation examines how governmental spending, in both health and nonhealth areas, can impact infant mortality rates.

Infant mortality remains high in the United States. Previous research indicates that government spending on services that aren’t linked to health care can lead to a reduction in infant mortality. However, which area of spending has the greatest impact remains unknown. A report in Pediatrics examines how spending impacted infant mortality rates.1

The researchers used the most recent data available, which was state and local government spending for 2000 to 2016. They looked at spending on education, social services, environment, and housing. They used linear regression models to assess how spending changes impacted infant mortality over time, overall and stratified by race and ethnicity and maternal age group.

They found that during the period 2000 to 2016, the average infant mortality was 6.6 per 1000 live births. When compared to their peers, infant mortality was twice as high among Black infants with 12.2 per 1000. The researchers found that the average governmental spending per person was $9. A per-person increase of $0.73 in social services spending was linked with a decrease of 0.02 deaths per 1000 live births. Additionally, a $0.30 per-person increase in environmental spending was linked with a decrease of 0.03 deaths per 1000 live births. Children born to mothers aged <20 years saw the greatest benefit from increases in governmental spending when compared to all other groups. Overall, increasing funding for public health, parks and recreation, housing, and solid waste management were linked with the highest reduction in the infant mortality rate.

Researchers noted some of their study’s limitations, which included the ecologic approach, which reduced their ability to control for individual factors as well as make causal inferences. They also noted that inefficiencies in the current spending could mean that people who most need them may not be able to receive them. Additionally, using geopolitically broad state boundaries could have prevented understanding subtle differences in populations.

The investigators concluded that governmental spending in nonhealth areas was tied to lower infant mortality rates, particularly in some high-risk populations. Continuing investments in these areas, social and environmental, could continue reducing the disparities seen in infant mortality rates.


1. Goldstein N, Palumbo A, Bellamy S, Purtle J, Locke R. State and local government expenditures and infant mortality in the United States. Pediatrics. October 19, 2020. Epub ahead of print. doi:10.1542/peds.2020-1134

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